| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
6,115 |
5,411 |
$374K |
| V2020 |
Frames, purchases |
7,487 |
6,181 |
$199K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
5,505 |
4,738 |
$131K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,518 |
1,306 |
$119K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
5,239 |
3,358 |
$66K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,137 |
1,445 |
$24K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,933 |
3,244 |
$22K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
866 |
509 |
$17K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
242 |
217 |
$12K |
| V2755 |
U-v lens, per lens |
2,386 |
1,810 |
$11K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
699 |
471 |
$8K |
| 92015 |
Determination of refractive state |
7,805 |
6,725 |
$8K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
163 |
119 |
$6K |
| 92341 |
|
394 |
286 |
$5K |
| 92370 |
|
73 |
69 |
$2K |
| V2760 |
Scratch resistant coating, per lens |
504 |
374 |
$371.58 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
16 |
14 |
$215.50 |
| S0516 |
Safety eyeglass frames |
12 |
12 |
$191.76 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
12 |
12 |
$107.28 |
| S9999 |
Sales tax |
12 |
12 |
$18.36 |
| V2025 |
Deluxe frame |
47 |
20 |
$0.00 |